Mikrochirurgischer Beckenkammtransfer nach erfolgter Caldwell-Luc-Operation

The standard Caldwell–Luc procedure includes the removal of most of the maxillary sinus mucosa and the introduction of an inferior meatal antrostomy to promote sinus drainage. Pain, chronic relapsing inflammation and loss of volume are typical sequels of this procedure. Partial maxillary resection and iliac crest bone graft harvesting is a new concept and treatment option in such cases. The case of a 64-year-old woman who had previously undergone several unilateral sinus operations is presented. Fluorescein imaging was used to detect bone areas of low blood perfusion in the sinus walls. All affected bone and granulation tissue were removed. After resection, an iliac crest bone graft with vascular pedicle was performed to reconstruct the maxillary defect. Postoperative CT and scintigraphic imaging revealed a vital transplant. At the 10-month follow-up, no inflammation was observed and chronic pain was significantly reduced. The results clearly demonstrate that maxillary resection and iliac crest bone graft harvesting might be an option to treat severe cases of chronic sinusitis. Further prospective studies are necessary to confirm the advantages of this technique.     

Donor-site morbidity after harvesting of radial forearm free flaps—comparison of vacuum-assisted closure with conventional wound care: A randomized controlled trial

IntroductionRadial forearm free flaps (RFFF) are often used to replace tissue removed in head and neck surgery. In recent years, many attempts have been made to reduce donor-site morbidity and to prevent common complications such as infection, skin-graft necrosis, tendon exposure and subsequent impairment of hand function. One promising option is the use of vacuum-assisted-closure wound therapy (VAC). The objective of this study was to evaluate the effectiveness of VAC compared with a conventional bolster dressing (CBD).Material and methodsA randomized controlled trial was enrolled. Our study was prospective in design and included patients with a skin-grafted forearm defect after harvesting of RFFF. Patients who met the inclusion criteria were randomly assigned into two study arms. The predictor variable was the type of wound therapy (VAC therapy compared with CBD) and the outcome variables were (1) the size of the wound area, (2) wrist movement and (3) grip strength. Outcome variables were assessed 12 days, three weeks and eight weeks after surgery.ResultsFifty patients (33 males, mean age 61.7 years [SD 15.5]; 17 females, mean age 54.7 years [SD 10.5]) were included consecutively in the study. Patients in the VAC group experienced a faster postsurgical reduction of wound area and had better wrist movement; nonetheless, the differences between the VAC group and CBD group did not reach statistical significance. In contrast, the recovery of postsurgical grip strength was significantly faster in the VAC group.ConclusionsOur study failed to prove that VAC therapy is significantly superior to CBD for all the variable studied. Because VAC therapy has some positive effects, however, we recommend further development of this negative-pressure wound treatment, rather than the termination of its use.     

Estimation of absolute left ventricular volume from gated radionuclide ventriculograms. A method using phase image assisted automated edge detection and two-dimensional echocardiography

Twenty-four patients underwent gated cardiac blood pool (GBP) imaging, two-dimensional echocardiography (2-D echo), and single-plane contrast ventriculography (within 24 hours). Variable left ventricular (LV) regions of interest on GBP images were identified by an automated threshold radial search. To avoid excluding LV counts we indexed the search threshold to the threshold identified by a phase image generated by Fourier analysis. LV depth calculated by 2-D echo was used for attenuation correction of LV counts. LV end-diastolic volume (EDV) and end-systolic volume (ESV) were calculated by dividing attenuation, background and deadtime corrected LV count rates by the background corrected count rate/ml of venous blood drawn during the study. Correlations between radionuclide and contrast volumes were good (EDV + ESV r = 0.97, EDV r = 0.94, ESV r = 0.95). Regression lines were close to the lines of identity. This method, in which GBP imaging and automated LV edge finding are complemented by 2-D echo for count attenuation correction, demonstrated reliable and reproducible noninvasive estimates of absolute LV volume.     

Pulmonary arterial hypertension associated with systemic sclerosis in the Czech Republic

Background  

Systemic sclerosis (SSc) is an important cause of pulmonary arterial hypertension (PAH), with an estimated prevalence of 7.85–26.7%.     

Monotonic Tension-Torsion Experiments and FE Modeling on Notched Specimens Produced by SLM Technology from SS316L

The aim of this work was to monitor the mechanical behavior of 316L stainless steel produced by 3D printing in the vertical direction. The material was tested in the “as printed” state. Digital Image Correlation measurements were used for 4 types of notched specimens. The behavior of these specimens under monotonic loading was investigated in two loading paths: tension and torsion. Based on the experimental data, two yield criteria were used in the finite element analyses. Von Mises criterion and Hill criterion were applied, together with the nonlinear isotropic hardening rule of Voce. Subsequently, the load-deformation responses of simulations and experiments were compared. Results of the Hill criterion show better correlation with experimental data. The numerical study shows that taking into account the difference in yield stress in the horizontal direction of printing plays a crucial role for modeling of notched geometries loaded in the vertical direction of printing. Ductility of 3D printed specimens in the “as printed” state is also compared with 3D printed machined specimens and specimens produced by conventional methods. “As printed” specimens have 2/3 lower ductility than specimens produced by a conventional production method. Machining of “as printed” specimens does not affect the yield stress, but a significant reduction of ductility was observed due to microcracks arising from the pores as a microscopic surface study showed.     

Placental passage of olomoucine II,but not purvalanol A,is affected by p-glycoprotein (ABCB1), breast cancer resistance protein (ABCG2) and multidrug resistance-associated proteins (ABCCs)

1.?Purine cyclin-dependent kinase inhibitors have recently been recognised as promising candidates for the treatment of various cancers. While pharmacodynamic properties of these compounds are relatively well understood, their pharmacokinetics including possible interactions with placental transport systems have not been characterised to date.

2.?In this study, we investigated transplacental passage of olomoucine II and purvalanol A in rat focusing on possible role of p-glycoprotein (ABCB1), breast cancer resistance protein (ABCG2) and/or multidrug resistance-associated proteins (ABCCs). Employing the in situ method of dually perfused rat term placenta, we demonstrate transplacental passage of both olomoucine II and purvalanol A against the concentration gradient in foetus-to-mother direction. Using several ATP-binding cassette (ABC) drug transporter inhibitors, we confirm the participation of ABCB1, ABCG2 and ABCCs transporters in the placental passage of olomoucine II, but not purvalanol A.

3.?Transplacental passage of olomoucine II and purvalanol A from mother to foetus is significantly reduced by active transporters, restricting thereby foetal exposure and providing protection against harmful effects of these xenobiotics. Importantly, we demonstrate that in spite of their considerable structural similarity, the two molecules utilise distinct placental transport systems. These facts should be kept in mind when introducing these prospective anticancer candidates and/or their analogues into the clinical area.